Home Visits, Innovation Models for Chronically Ill Flashcards
What is Different Now?
- Status Quo is ____ working
- Quality/Cost and V____
- Ag____ Population
- F_____ Unit
- M______
- Status Quo is NOT working
- Quality/Cost and Value
- Aging Population
- Family Unit
- Mobility
+COVID
How is the US doing: Quality vs. Cost compared to other countries?
We have the highest healthcare spending with the lowest health system performance
US _____ Spending is Similar to Other Countries; (2) Spending Are Higher Than Most
US Public Spending is Similar to Other Countries; Out of Pocket and Private Spending Are Higher Than Most
US Cost of Healthcare vs. Social Spending?
We don’t spend that much on social spending but literally the highest in healthcare, denmark is a good example
US Population Health Quality Metrics
- Life expectancy vs. other countries?
- Infant mortality vs. other countries?
- 65+ with 2 or more chronic conditions vs. other countries?
- Obesity rate vs. other countries?
- Smoking?
- Pretty low life expectancy
- Highest neonatal mortality
- Highest # of 65+ with chronic conditions, lower percentage of people above 65
- Highest obesity rate
- Lower rates of smoking
Summary of US Health and Quality Outcomes
- Life expectancy =
- Suicide rate =
- Chronic disease burden =
- Hip replacement =
- 5 year survival for cervical cancer =
- Rates of hospitalization from preventable causes like DM and HTN =
- Rate of avoidable death =
- Life expectancy = Lowest
- Suicide rate = Highest
- Chronic disease burden = Highest
- More hip replacements
- 5 year survival for cervical cancer = Lowest
- Rates of hospitalization from preventable causes like DM and HTN = Highest
- Rate of avoidable death = Highest
Summary of US Health and Quality Outcome Cont.
- # of physician visits =
- Average hospitalization =
- Rate of MRI scan =
- Prevention for breast cancer and flu =
- Average 5 year survival rate of breast CA =
- # of physician visits = Less
- Average hospitalization = Middle (similar to france and switzerland)
- Rate of MRI scan = Highest rate
- Prevention for breast cancer and flu = High prevention
- Average 5 year survival rate of breast CA = Highest average
Effect of Covid on Mental Health?
Prevalence of anxiety and depression more than doubled the levels prior to the pandemic
(Huge mental health burden)
Aging Population
- The number of individuals aged 60 years and over is expected to increase globally from 841 million to 2013 to more than __ billion by 2050
- By 2030, the number of US adults aged 65 or older will more than double to about ___ million
- Uprecedented demands on the provision of healthcare and aging-related services
- The number of individuals aged 60 years and over is expected to increase globally from 841 million to 2013 to more than 2 billion by 2050
- By 2030, the number of US adults aged 65 or older will more than double to about 71 million
- Uprecedented demands on the provision of healthcare and aging-related services
Does the US invest in long term care?
No, the US spends more on administrative costs and less on long term healthcare than other wealthy countries
What is the distribution of health care spending for US Civilian Non-Institutionalized Population?
(Who spends the most??
Top 5% of spenders account for 50.4% of spending
What type of care do we spend the most on?
We spend way more on hospitalizations
High-need adults had higher spending on health care than those with three of more chronic conditions without functional limitations
Top 5% spends the most on health care even when?
Top 5% spends the most on health care even for the same conditions that others have
Preventable Spending by Category
We spend the most on preventative spending for those who are (1) and the least on (1)
We spent the most on preventable spending for those already frail, disabled, and major complex chronic illnesses and the least on those who are relatively healthy
Waste in the US Health Care System
Top (3) Categories
Administrative
Operational
Clinical waste
Potential Savings from Interventions
- Failure of care d____
- Failure of care c_____
- ____treatment/___-value care
- Pr____ failure
- Fr___ and Ab_____
- Failure of care delivery
- Failure of care coordination
- Overtreatment/low-value care
- Pricing failure
- Fraud and Abuse
Social Determinants of Health
Median Annual Medicare Spending, by Disability and Experience of Negative Consequences Due to Inadequate Support
We medicare spends the most on?
Self care for those with disabilities and negative consequences
Where are we today?
- H______ care is costly
- Patients prefer to be treated at _____
- COVID showed us things _____ to be done differently
- Home care reimbursement is ___creasing
- Chronic disease burden: the more, the _____ outcome
- F______ status is KEY
- W_____ in Healthcare: redundancy
- Care_____/____liness
- Hospital care is costly
- Patients prefer to be treated at home
- COVID showed us things NEED to be done differently
- Home care reimbursement is increasing
- Chronic disease burden: the more, the worse outcome
- Functional status is KEY
- Waste in Healthcare: redundancy
- Caregiving/loneliness
How are we addressing these cases?
- Try to identify the population at r____/HNHC (high need high cost): lack of a common def_____
- Need a more holistic T___ based approach
- Unmet physical, ps____ and s_____ needs
- Issue with coordination of care, mis_____ incentives
- Integrated data (hospitalization/ER utilization, readmissions, diagnosis…): AI and predictive analytics
- Try to identify the population at risk/HNHC: lack of a common definition
- Need a more holistic TEAM based approach
- Unmet physical, psychological and social needs
- Issue with coordination of care, misaligned incentives
- Integrated data (hospitalization/ER utilization, readmissions, diagnosis…): AI and predictive analytics
Model of Cares
- S_____ clinics
- Hy_____ model
- V_____ health
- Hospital at h___
- S_ _ virtual
- TOC support =
- Senior clinics
- Hybrid model
- Virtual health
- Hospital at home
- SNF virtual
- TOC support = transition of care support
When can you treat a patient at home?
3 settings
1) P____ care/Ger_____
2) Tr______ care visit
3) Acute s______ management/p______ care: crisis management and prevention
1) Primary care/Geriatrics
2) Transitional care visit
3) Acute symptom management/palliative care: crisis management and prevention
Comprehensive Assessment
- F____ and safety assessment (rugs, clutters…)
- Activities of (2)
- L____liness
- Dep____
- Fr____
- F____ insecurity (check the fridge, the pantry…)
- Me)______ review
- Fall and safety assessment (rugs, clutters…)
- ADA, IADL
- Loneliness
- Depression
- Frailty
- Food insecurity (check the fridge, the pantry…)
- Medication review
What can we treat at home?
(1)
- F______: 20-50% may lack fever, low grade temperature or hypothermia
- Change in _______ status: not alone, be careful in dementia/overdiagnosis, need workup
- Reason for difference: impaired thermoregulation, hypothalamus regulation, decrease response in immune system
- P______ analysis: location: hospitalization, adult daycare, risk factors: dialysis, catheter, recent infection
Infection
- Fever: 20-50% may lack fever, low grade temperature or hypothermia
- Change in mental status: not alone, be careful in dementia/overdiagnosis, need workup
- Reason for difference: impaired thermoregulation, hypothalamus regulation, decrease response in immune system
- Pathogens analysis: location: hospitalization, adult daycare, risk factors: dialysis, catheter, recent infection
Consideration for Treatment
- What lab value?
- Do we start abx at a lower dose for elderly?
- In_______with other medication
- Antibiotics St_______ MRSA, VRE, FQ resistant strep pneumo and MDR Gram negative bacilli
- _____ coverage
- Cl______ d_______
- GFR
- Do NOT “start low and go slow” (for abx)
- Interaction with other medication
- Antibiotics Stewardship: MRSA, VRE, FQ resistant strep pneumo and MDR Gram negative bacilli
- Broad coverage
- Clostridium Difficile
COPD Treatment/Education
Constipation Treatment
Bulking agents (3)
Osmotic Laxatives (5)
Stool softeners (1)
Stimulant Laxative (2)
Chloride channel activators (1)
Peripherally acting mu-opioid antagonist (1)
Other (1)
Nonpharm Therapies for Management of Alzheimer Disease
- Enjoyable l____ activities
- Mental st_____ programs
- O______ therapy
- Structured ph_____ exercise programs
- Enjoyable leisure activities
- Mental stimulation programs
- Occupational therapy
- Structured physical exercise programs
Social Determinants of Health
- Caregiving
- Caregiving st____
- Ad_____ care planning
- Real time co____ of care
- S______ assessment
- Partnership with CBO (community based organization) for f____
- Health lit______
- Caregiving
- Caregiving stress
- Advance care planning
- Real time coordination of care
- Safety assessment
- Partnership with CBO for food
- Health literacy
Falls
- Screening
- Did you fall in the last ___ months? Ba___ issue?
- Evaluate in person:
- R___, furniture, path, bathroom
- Assess:
- Med_____
- Hy__tension
- F____ problem
- Educate
- Screening
- Did you fall in the last 12 months? Balance issue?
- Evaluate in person:
- Rug, furniture, path, bathroom
- Assess:
- Medication
- Hypotension
- Foot problem
- Educate
Hospice Discussion
- How to present hospice
- Have the right partnership:
- Fast hospice ad_____, weekend
- Fast res______ to patient’s need
- Medication/opioid del_____
- S_____ support
- Stay inv______
- How to present hospice
- Have the right partnership:
- Fast hospice admission, weekend
- Fast response to patient’s need
- Medication/opioid delivery
- Social support
- Stay involved
Advanced Illness Programs
(4)
- Aetna Compassionate Care
- Aspire Health
- Northwell Health Advanced Illness Management
- Sutter Health Advanced Illness Management
Issue: The Payment Model
How are most providers paid?
Fee for service
